Rick dodged a bullet

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I got this one a few days ago and just received clearance to drop it on DC. Arizona homeboy and all around good guy Rick Cimaglia ran into a spot of trouble recently.

From: Rick
Hey All:
Word usually gets out fast in the cycling world, and if you haven’t heard yet, I am on the injured reserve list. I had a close call, developing a DVT (Deep Venous Thrombosis) or blood clot in my R lower leg. I went to the ER Monday night to get checked out, did a few tests, found out I had not only a clot in my leg, but also had bilateral pulmonary emboli (clots to the lungs). They admitted me, put me on blood thinners right away and said… bed rest, so as not to throw any more pieces of the clot to my lungs. I was discharged Wednesday afternoon.

What led up to that point? Well, after Summit Center, I had the usual hacking cough all week from the Mars Hill Prologue effort. About Wednesday of that week I started having mid back spasms on the right side, that would trigger with inhalation. These were not unfamiliar feelings or episodes, having had similar problems in the past, like an intercostal muscle spasm when a rib feels involved. It responded to manual musculoskeletal treatments, became intermittent and gradually was getting better. At some point later in that week after the race I started having right calf pain, that also felt like pain I have had in the past. Both symptoms would get better with riding, although I felt like I had no top end power, and have had that problem all season. By last weekend, my chest/back spasm symptom was minimal, but the calf pain was stubborn. It worsened last Sunday, and I even took Sunday and Monday off the bike to recover. Sunday night I had trouble sleeping with difficulty finding a comfortable position that relaxed my leg, restless all night. The ache worsened throughout my workday on Monday, tolerating less and less weight bearing, had difficulty walking with pain at the end of stride on the right leg, corresponding to a calf problem. After work Monday, I hit the couch to rest, but my lower leg felt worse, and started swelling. I measured my calf over 1 inch bigger that the left, but not discolored.

I said to my wife, HL, “look at the size of my calf”. While looking, she said, “look at your ankle! You have a cankle!!”. Only the inner side of my ankle was swollen and I was very tender along the inner shin. I called a couple doctor friends to decide whether to go to the ER. I was resigned to the fact I was going to get it checked out the next day no matter what, but was this an emergency? The first guy I talked to reassured me that the likelihood of it being a clot is low, but there is no guarantee; 50% of time you think there is no clot and there is, 50% of time you think there is a clot and there isn’t. I didn’t even mention the chest symptom I had earlier, because it wasn’t bothering me for days and didn’t make the connection. Then I spoke with another Dr friend, and after going through the history of symptoms, he said, “and you said you don’t have any chest pain, right?”, “Right, I said”, then I paused, the light bulb went off. “No chest pain right now, but I did have a real problem with spasms a week ago”. That made him nervous, and he said “I think it would be a good idea to go in to get this checked out. If it’s not a clot, great, you have peace of mind.”

Well, it was a good thing I went in. I was, and still am, a walking ticking time bomb. I went in around 7:45pm, and after all the waiting and testing in the ER, was admitted to the hospital at 3am. That was a long night. On Wednesday, I was discharged to my family doctors care, and I am self-injecting Lovenox every 12hrs in my abdomen, and was started on Coumadin (Warfarin). I am off work until next week, and will have to limit prolonged standing or sitting times for several weeks when I return. I can’t exercise at all for a month. I have to get my blood checked daily to assure that it is thinning properly. There is a quick check with a pin-prick of blood, run through a portable machine, like a glucometer or a lactate machine, but this measures prothrombin time (PT), or how fast the blood clots. I will be on blood thinner for at least 6mths. Racing is out, but I plan on return to riding as soon as possible, but will need to be careful. A crash while on blood thinners is not a good thing. I am already frustrated, as I feel fine, other than an achy calf. I don’t feel on the edge of death’s doorstep, but I guess I am pretty lucky. Supposedly, pulmonary embolism has close to a 30% mortality rate……….Yikes!!

We now return you to your regularly scheduled program…………………….

Take it easy, Rick. And get better soon from all of us at Drunkcyclist.

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About big jonny

The man, the legend. The guy who started it all back in the Year of Our Lord Beer, 2000, with a couple of pages worth of idiotic ranting hardcoded on some random porn site that would host anything you uploaded, a book called HTML for Dummies (which was completely appropriate), a bad attitude (which hasn’t much changed), and a Dell desktop running Win95 with 64 mgs of ram and a six gig hard drive. Those were the days. Then he went to law school. Go figure. Flagstaff, Arizona, USA

5 Replies to “Rick dodged a bullet”

  1. A girl I used to work with had something very similar happen to her and was on the blood thinner for 6 months…the big downside for her was no booze during the 6 months of meds! Yikes!!

  2. Good looking out to you doctor buddies. I just graduated with a degree in respiratory medicine and get to see this all the time. A big thanks for your detailed description of you symptoms with the timeline. Alot of people have a hard time putting it all together and seeing how related they are. This thing coulda dropped you like a rock while in line at the store. Now it sounds like your gonna be around for quite a while. Well done.

  3. Very big lesson to learn indeed…now, this is a rare occurence to have this problem in a healthy athlete..usually seen in larger amounts of lower extremity trauma or surgery that is followed by convalescence(I usually have my patients go on Lovenox postoperatively if they are overweight, older, on birth control pills, smoke and are having a foot or ankle surgery that is going to last more than one hour).

    I’m just thankful that this problem wasn’t ignored any longer, or a dirt nap might have been the outcome….good luck with your recovery


  4. Holy smokes, Rick! glad you’re ok. That prologue ought to be outlawed. few races are that steep and that short at 8000 feet. i love doing it, but when it’s over i’m coughing for two weeks. ugh.

    take care and rest. see you when you’re back to 100%. let me know if you need contacts in Montana.
    -flagstaffist (ben)

  5. Thanks for the responses. I am currently recovering, am on coumadin, working full time again after an initial week off, and am feeling good. I still have mild edema in the lower leg, but stable with no flare up of symptoms like I had initially.

    I’ll be back…………rick